Emergencies caused by acute neurological disorders and injuries are common and the health burden of these conditions to patients and society is well documented. The outcome of many neurological disorders is often determined within the first minutes after onset and intervention in the emergency department or even prior to emergency department arrival may be necessary to provide meaningful benefit. The optimal treatments for these conditions are not well described, in part because the clinical research in the United States has not conducted many intervention trials targeting the earliest phases of treatment. Another obstacle facing investigators is the ability to enroll a sufficient number of volunteers to obtain statistical significance in testing the intervention. To overcome these challenges, the National Institutes of Neurological Disease and Strokes (NINDS) endeavors to create a wide network of major and community hospitals, referred to as the "hub and spoke" model. This model seeks to capture a wide socio-demographic profile including minority and underserved individuals, while obviating protracted timelines implicit in clinical trials. NINDS has selected the Department of Emergency Medicine at the University of Michigan as the Clinical Coordinating Center, and a data coordinating site will be identified. Our team will contribute significantly to this network by incorporating three major hospitals from Arizona's two metropolitan areas and four rural hospitals. The hub and spoke design of the Arizona Neurological Emergencies Treatment Trials Network (AzNETT) will be enhanced by incorporating rural hospitals already included in the University of Arizona's Telemedicine Program. Through this growing infrastructure, we will be able to investigate the effectiveness of new therapies in a broader range of service environments, while striving to augment the quality of patient care. The key elements of this structure will include an interdisciplinary team of emergency physicians, neurologists, neurosurgeons, coordinators, program managers and information technologists with specific expertise in the conduct of emergent clinical trials. Team members in both the hub and spoke sites have demonstrated a long term commitment to advancing the national research infrastructure as it relates to the interdisciplinary study of emergent illness.